Chapter 20 COPD

A client with chronic obstructive pulmonary disease (COPD) reports increased shortness of breath and fatigue for 1 hour after awakening in the morning. Which of the following statements by the nurse would best help with the client's shortness of breath and fatigue?

"Delay self-care activities for 1 hour."

A client with chronic obstructive pulmonary disease (COPD) expresses a desire to quit smoking. The first appropriate response from the nurse is:

"Have you tried to quit smoking before?"

The nurse is reviewing metered-dose inhaler (MDI) instructions with a patient. Which of the following patient statements indicates the need for further instruction?

"I can't use a spacer or holding chamber with the MDI."

A nurse has just completed teaching with a patient who has been prescribed a meter-dosed inhaler for the first time. Which of the following statements would the nurse use to initiate further teaching and follow-up care?

"I do not need to rinse my mouth with this type of inhaler."

A home health nurse visits a client with chronic obstructive pulmonary disease who requires oxygen. Which statement by the client indicates the need for additional teaching about home oxygen use?

"I make sure my oxygen mask is on tightly so it won't fall off while I nap."

A physician orders metaproterenol (Alupent) by metered-dose inhalation four times daily for a client with acute bronchitis. Which statement by the client indicates effective teaching about this medication?

"I need to hold my breath as long as possible after I take a deep inhalation."

A client with chronic obstructive pulmonary disease (COPD) and cor pulmonale is being prepared for discharge. The nurse should provide which instruction?

"Weigh yourself daily and report a gain of 2 lb in 1 day."

A patient with end-stage COPD and heart failure asks the nurse about lung reduction surgery. What is the best response by the nurse?

"You and your physician should discuss the options that are available for treatment."

After reviewing the pharmacological treatment for pulmonary diseases, the nursing student knows that bronchodilators relieve bronchospasm in three ways. Choose the correct three of the following options.

-Alter smooth muscle tone -Reduce airway obstruction -Increase oxygen distribution

A nursing student knows that there are three most common symptoms of asthma. Choose the three that apply.

-Cough -Wheezing -Dyspnea

A nursing student is taking a pathophysiology examination. Which of the following factors would the student correctly identify as contributing to the underlying pathophysiology of chronic obstructive pulmonary disease (COPD)? Choose all that apply.

-Inflamed airways that obstruct airflow -Mucus secretions that block airways -Overinflated alveoli that impair gas exchange

Following are statements regarding medications taken by a patient diagnosed with COPD. Choose which statements correctly match the drug name to the drug category. Select all that apply.

-Prednisone is a corticosteroid. -Albuterol is a bronchodilator. -Ciprofloxacin is an antibiotic.

A patient presents to the ED experiencing symptoms of COPD exacerbation. The nurse understands there are goals of therapy that are achieved to improve the patient's condition. Which of the following are therapy goals? Select all that apply.

-Provide medical support for the current exacerbation. -Treat the underlying cause of the event. -Return the patient to his original functioning abilities. -Provide long-term support for medical management.

A nursing instructor is discussing asthma and its complications with medical-surgical nursing students. Which of the following would the group identify as complications of asthma? Choose all that apply.

-Status asthmaticus -Respiratory failure -Atelectasis

To help prevent infections in clients with COPD, the nurse should recommend vaccinations against two bacterial organisms. Which of the following are the two vaccinations?

-Streptococcus pneumonia -Haemophilus influenzae

Which of the following is a clinical manifestation of a pneumothorax? Select all that apply.

-Sudden chest pain -Asymmetry of chest movement -Unilateral retractions -Oxygen desaturation

A client with asthma has developed obstruction of the airway. Which of the following does the nurse understand as having potentially contributed to this problem? Choose all that apply.

-Thick mucus -Swelling of bronchial membranes -Airway remodeling

The goal for oxygen therapy in COPD is to support tissue oxygenation, decrease the work of the cardiopulmonary system, and maintain the resting partial arterial pressure of oxygen (PaO2) of at least ______ mm Hg and an arterial oxygen saturation (SaO2) of at least ___%.

60 mm Hg; 90%

Emphysema is described by which of the following statements?

A disease of the airways characterized by destruction of the walls of overdistended alveoli

Which of the following is accurate regarding status asthmaticus?

A severe asthma episode that is refractory to initial therapy

A physician orders a beta2 adrenergic-agonist agent (bronchodilator) that is short-acting and administered only by inhaler. The nurse knows this would probably be

Albuterol

Which of the following is the strongest predisposing factor for asthma?

Allergy

A nurse is caring for a client with status asthmaticus. Which medication should the nurse prepare to administer?

An inhaled beta2-adrenergic agonist

A client with chronic obstructive pulmonary disease (COPD) is admitted to an acute care facility because of an acute respiratory infection. When assessing the client's respiratory status, which finding should the nurse anticipate?

An inspiratory-expiratory (I:E) ratio of 2:1

A client is diagnosed with a chronic respiratory disorder. After assessing the client's knowledge of the disorder, the nurse prepares a teaching plan. This teaching plan is most likely to include which nursing diagnosis?

Anxiety

The pathophysiology of emphysema is directly related to airway obstruction. The end result of deterioration is respiratory acidosis from airway obstruction. Knowing this, the nursing student would choose which of the following as the highest priority action?

Assess vital signs every 2 hours including O2 saturations and ABG results.

The nurse should be alert for a complication of bronchiectasis that results from a combination of retained secretions and obstruction and that leads to the collapse of alveoli. What complication should the nurse monitor for?

Atelectasis

The nurse should be alert for a complication of bronchiectasis that results from a combination of retained secretions and obstruction that leads to the collapse of alveoli. This complication is known as

Atelectasis *Retention of secretions and subsequent obstruction ultimately cause the aveoli distal to the obstruction to collapse (atelectasis).

Which of the following is true about both lung transplant and bullectomy?

Both are aimed at improving the overall quality of life of a patient with COPD.

Which of the following is a leading cause of chronic obstructive pulmonary disease (COPD) exacerbation?

Bronchitis

A young adult with cystic fibrosis is admitted to the hospital for aggressive treatment. The nurse first:

Collects sputum for culture and sensitivity

A client has asthma. Which of the following medications is a commonly prescribed mast cell stabilizer used for asthma?

Cromolyn sodium

A home health nurse sees a client with end-stage chronic obstructive pulmonary disease. An outcome identified for this client is preventing infection. Which finding indicates that this outcome has been met?

Decreased oxygen requirements

Which of the following is a symptom diagnostic of emphysema?

Dyspnea

A junior-level nursing class has just finished learning about the management of clients with chronic pulmonary diseases. They learned that a new definition of COPD leaves only one disorder within its classification. Which of the following is that disorder?

Emphysema

Which of the following is a common irritant that acts as a trigger of asthma?

Esophageal reflux

A client has chronic obstructive pulmonary disease (COPD) and is exhibiting shallow respirations of 32 breaths per minute, despite receiving nasal oxygen at 2 L/minute. To improve the client's shortness of breath, the nurse encourages the client to

Exhale slowly

The nurse has instructed the client to use a peak flow meter. The nurse evaluates client learning as satisfactory when the client

Exhales hard and fast with a single blow

Which of the following exposures accounts for the majority of cases with regard to risk factors for chronic obstructive pulmonary disease (COPD)?

Exposure to tobacco smoke

A nurse evaluates the results of a spirometry test to help confirm a diagnosis of obstructive lung disease. Which one of the following results indicates an initial early stage of COPD? (FEV1 refers to forced expired volume in 1 second.)

FEV1 > 80% *The FEV1 decreases as the severity of obstruction increases. Therefore, an FEV1 of more than 80% indicates an initial stage, and an FEV1 of 30% indicates a very severe stage.

A nurse consulting with a nutrition specialist knows it's important to consider a special diet for a client with chronic obstructive pulmonary disease (COPD). Which diet is appropriate for this client?

High-protein

A nurse notes that the FEV1/FVC ratio is less than 70% and the FEV1 is 65% for a patient with COPD. What stage should the nurse document the patient is in?

II

In which stage of COPD is the forced expiratory volume (FEV) less than 30%?

III

Asthma is cause by which type of response?

IgE-mediated

A patient with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this patient includes which of the following?

Implementing measures to clear pulmonary secretions

A client with symptoms of mild persistent asthma is now initiating treatment. Which of the following is the preferred therapy that the nurse will teach the client to use at home?

Inhaled beclomethasone (Beconase)

A client has a history of chronic obstructive pulmonary disease (COPD). Following a coughing episode, the client reports sudden and unrelieved shortness of breath. Which of the following is the most important for the nurse to assess?

Lung sounds

Histamine, a mediator that supports the inflammatory process in asthma, is secreted by

Mast cells

Which of the following medications are classified as leukotriene modifiers (inhibitors)? Select all that apply.

Montelukast (Singulair) Zafirlukast (Accolate) Zileuton (Zyflo)

A client is being seen in the emergency department for exacerbation of chronic obstructive pulmonary disease (COPD). The first action of the nurse is to administer which of the following prescribed treatments?

Oxygen through nasal cannula at 2 L/minute

The nurse is assigned the care of a 30-year-old female patient diagnosed with cystic fibrosis (CF). Which of the following nursing interventions will be included in the patient's plan of care?

Performing chest physiotherapy as ordered

An increase in the red blood cell concentration in the blood is termed which of the following?

Polycythemia

The nurse is educating a patient with asthma about preventative measures to avoid having an asthma attack. What does the nurse inform the patient is a priority intervention to prevent an asthma attack?

Preparing a written action plan

A child is having an asthma attack and the parent can't remember which inhaler to use for quick relief. The nurse accesses the child's medication information and tells the parent to use which inhalant?

Proventil

A patient with asthma is prescribed a short acting beta-adrenergic (SABA) for quick relief. Which of the following is the most likely drug to be prescribed?

Proventil

The nurse is assigned to care for a patient with COPD with hypoxemia and hypercapnia. When planning care for this patient, what does the nurse understand is the main goal of treatment?

Providing sufficient oxygen to improve oxygenation

A patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure?

Respiratory acidosis

As status asthmaticus worsens, the nurse would expect which acid-base imbalance?

Respiratory acidosis

In chronic obstructive pulmonary disease (COPD), decreased carbon dioxide elimination results in increased carbon dioxide tension in arterial blood, leading to which of the following acid-base imbalances?

Respiratory acidosis

The nurse, caring for a patient with emphysema, understands that airflow limitations are not reversible. The end result of deterioration is:

Respiratory acidosis.

A nurse administers albuterol (Proventil), as ordered, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect?

Respiratory rate of 22 breaths/minute

A patient comes to the clinic for the third time in 2 months with chronic bronchitis. What clinical symptoms does the nurse anticipate assessing for this patient?

Sputum and a productive cough

The nurse is instructing the patient with asthma in the use of a newly prescribed leukotriene receptor antagonist. What should the nurse be sure to include in the education?

The patient should take the medication an hour before meals or 2 hours after a meal.

The nurse is assigned to care for a patient in the ICU who is diagnosed with status asthmaticus. Why does the nurse include fluid intake as being an important aspect of the plan of care? (Select all that apply.)

To combat dehydration To loosen secretions To facilitate expectoration

Which of the following would not be considered a primary symptom of COPD?

Weight gain

Upon assessment, the nurse suspects that a patient with COPD may have bronchospasm. What manifestations validate the nurse's concern? (Select all that apply.)

Wheezes Compromised gas exchange Decreased airflow

At 11 p.m., a client is admitted to the emergency department. He has a respiratory rate of 44 breaths/minute. He's anxious, and wheezes are audible. The client is immediately given oxygen by face mask and methylprednisolone (Depo-medrol) I.V. At 11:30 p.m., the client's arterial blood oxygen saturation is 86%, and he's still wheezing. The nurse should plan to administer:

albuterol (Proventil).

A client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can't produce an effective cough, the nurse should monitor closely for:

atelectasis.

A nurse is assisting with a subclavian vein central line insertion when the client's oxygen saturation drops rapidly. He complains of shortness of breath and becomes tachypneic. The nurse suspects the client has developed a pneumothorax. Further assessment findings supporting the presence of a pneumothorax include:

diminished or absent breath sounds on the affected side.

The classification of Stage I of COPD is defined as

mild COPD.

The classification of Stage II of COPD is defined as

moderate COPD.

A client is being admitted to an acute healthcare facility with an exacerbation of chronic obstructive pulmonary disease (COPD). The client had been taking an antibiotic at home with poor relief of symptoms and has recently decided to stop smoking. The nurse is reviewing at-home medications with the client. The nurse is placing this information on the Medication Reconciliation Record. Which of the following is incomplete information?

salmeterol/fluticasone (Seretide) MDI daily at 0800

The classification of Stage III of COPD is defined as

severe COPD.

A nurse is caring for a client experiencing an acute asthma attack. The client stops wheezing and breath sounds aren't audible. This change occurred because:

the airways are so swollen that no air can get through.